Transforming Community Services Research Articles

Policy paradox and political neglect in community health services.

Community health services (CHSs) have never had a settled organisational existence but the turmoil has intensified since the publication of Transforming Community Services in 2009. CHSs are now beset by three dilemmas: ongoing organisational fragmentation; the extension of competition law and the spread of privatisation; inadequate workforce development and lack of clarity on the nature of CHS activity. This has left the services in a position of policy and political vulnerability. The solution may be for the service to be part of horizontal integration models such as the accountable care organisation, with a focus on locality and multi-professional teams wrapped around patient pathways.

Transforming community services through the use of a multidimensional model of clinical leadership.

To evaluate the application of a Multidimensional Model of Clinical Leadership on the community healthcare leader and on transforming community services. Healthcare policy advocates clinical leadership as the vehicle to transform community and healthcare services. Few studies have identified the key components of an effective clinical leadership development model. The first two stages of Kirkpatrick's (Personnel Administrator 28, 1983, 62) Four/Five Levels of Evaluation were used to evaluate the application of the multidimensional model of clinical leadership. Eighty community healthcare leaders were exposed to this multidimensional clinical leadership development model through attendance of a community clinical leadership development programme. Twenty five leaders participated in focus group interviews. Data from the interviews were analysed utilising thematic content analysis. Three key themes emerged that influenced the development of best practice principles for clinical leadership development: 1. Personal leadership development 2. Organisational leadership 3. The importance of multiprofessional action learning/reflective groups Emergent best practice principles for clinical leadership development include adopting a multidimensional development approach. This approach encompasses: preparing the individual leader in the role and seeking organisational leadership development that promotes the vision and corporate values of the organisation and delivers on service improvement and innovation. Moreover, application of the Multidimensional Model of Clinical Leadership could offer the best platform for embedding the Six C's of Nursing (Compassion in Practice - Our Culture of Compassionate Care, Department of Health, Crown Copyright, 2012) within the culture of the healthcare organisation: care, compassion, courage, commitment, communication, and competency. This is achieved in part through the application of emotional intelligence to understand self and to develop the personal integrity of the healthcare leader and through supporting a culture of lifelong leadership learning. Embedding the best practice principles of clinical leadership development within a multidimensional model of clinical leadership provides a promising approach to: equipping the healthcare leader with those transferable leadership skills required to help them embark on a journey of lifelong leadership learning; and producing the healthcare leader who is caring, compassionate and can confidently and effectively transform community services.

A changing landscape: mapping provider organisations for community nursing services in England

To scope the provision of community nursing services in England after implementation of the Transforming Community Services Programme. Over the past decade, significant UK policy initiatives have shaped the structure, organisation and responsibilities of community nursing services. Understanding these organisational changes is important in the context of organisations seeking to deliver 'care closer to home'. A systematic mapping exercise to scope and categorise community nursing service organisation provider models. There are 102 provider organisations representing a range of organisational models. Two-thirds of these organisations have structurally integrated with another NHS Trust. Smaller numbers reorganised to form community trusts or community interest companies. Only a few services have been tendered to an accredited willing provider while a small number have yet to establish their new service model. Local discretion appears to have dominated the choice of organisational form. National policies have driven the reorganisation of community nursing services and we have been able to describe, for the first time, these 'transformed' structures and organisations. Providing detail of these 'new' models of service provision, and where these have been introduced, is new information for nurse managers, policy makers and organisational leaders, as well as researchers.

Unintended consequences? The impact of NHS reforms upon Torbay Care Trust

PurposeTorbay Care Trust has been widely promoted as an effective model of integrated health and social care, and yet the impact of reforms introduced by the previous and current governments has been to destabilise its partnership coherence and its organisational form. This paper seeks to explain why this is the case, highlighting the potentially damaging consequences for the local, currently productive, system of care; and to indicate the local adaptations necessary to maintain progress, which are seen as under continuing threat in the current financial environment.Design/methodology/approachThis is a personal reflection by the chief executive of Torbay Care Trust, reviewing the documented progress made since 2005.FindingsThe model of partnership, collaboration and risk sharing carefully nurtured over 15 years in Torbay has been proven to be beneficial not only for local people, but for NHS financial and clinical performance generally, and for social care performance. This is now paradoxically being undermined by the more commercially‐minded policy approaches of Labour's Transforming Community Services programme and by the current NHS reforms. New tensions have arisen across the “health and social care divide”.Originality/valueThe current government is unequivocally committed to integrated care, and specifically to integrated health and social care. The Torbay experience gives insight firstly into the care and attention which may be needed by government to secure this over forthcoming years; and secondly to the way in which integrated commissioning will have to be conceived and organised in the new system, and how integrated services will have, in turn, to be commissioned, and operated.

The future for mental health non-medical prescribers

The NHS Plan ( Department of Health, 2000 ) envisaged that widening the scope of nurse prescribing would offer service improvement by reducing delays incurred through waiting for a doctor to prescribe. To date, 14% of the mental health nurse prescribers in Rotherham, Doncaster and South Humber NHS Trust are prescribing independently. The Transforming Community Services initiative, with its transfer of community practitioners, has highlighted differences in prescriptive authority. This article describes how research into non-medical prescribing within Rotherham, Doncaster and South Humber NHS Foundation Trust has been used to inform service delivery.

NHS south of Tyne and Wear's supportive and palliative care standards for end of life care in care homes

Around 500 000 people die in England each year. The vast majority (around 99%) of deaths occur in adults over the age of 18 years. Most deaths occur in people...

Benefits of mobile working for community nurse prescribers

This article examines the professional considerations that motivate the adoption of mobile working by nurse prescribers in England. The article presents some of the findings of an ongoing Transforming Community Services Programme pilot study of mobile working in the community by the Department of Health. The benefits and challenges associated with mobile technology are discussed in addition to the importance of clinical leadership and engagement.

Transforming community services

The Department of Health-led programme, Transforming Community Services (TCS), has, since its introduction in Autumn 2008 created a huge volume of work for myself, other Royal College of Nursing colleagues and NHS managers who are connected to community health services.

Improving end of life care in the community: national strategy

The National End of Life Care Strategy published last year by the Department of Health called for a 'cultural shift' among the 2.5m strong health and social care workforce. This article explores the competence and principles which those staff should have to provide improved care for those at the end of their lives. It links these to Transforming End of Life Care, one of six guides in the 'Transforming Community Services' series which emerged from the 'NHS Next Stage Review' led by Lord Darzi. Together the three documents explored in this article call for a new emphasis on partnership working and teamwork to provide care that is responsive to the wishes of the person nearing the end of his or her life and their loved ones.

Testing transformational guides

Rosemary Cook outlines concerns raised by community nurses during a project to test the Transforming Community Services programme in practice

Time to invest in the community

Achieving progress on Transforming Community Services (TCS) (Department of Health 2009) is going to be difficult with the likely reduction in funding. And yet, there is sense in taking advantage of this time of economic austerity to invest in community health services.

The Darzi report: implications for tissue viability nurses

'Transforming community services' (Darzi, 2009) is the second healthcare report to be authored by Lord Ara Darzi, which was published in July 2009. As the title suggests, it targets community services and includes specific, and sometimes disingenuous, implications for tissue viability in the community setting.

Less reflection and more action is needed

In their opinion piece published in this week's issue of British Journal of Nursing,1 Richard White and Keith Cutting talk about the implications for nurses of the recent Darzi report on transforming community services.2 They observe that the report gives scant acknowledgement to the full and varied role that tissue viability practitioners play in the community. Indeed, White and Cutting comment that the term ‘tissue viability’ is used only 100 times in the 100-page report. This state of affairs where tissue viability is regarded as a rather quaint backwater is sadly all too familiar.

The Darzi Report and tissue viability services

The recent report Transforming community services: Ambition, Action, Achievement (Department of Health (DH), 2009), is the second to be authored by Lord Ara Darzi and follows in the wake of his review of the NHS in England, High Quality Care for All (DH, 2008).

Transforming community services.

I am responding to the letter in the June issue of Nursing Management about Transforming Community Services (TCS).

Transforming community services

Transforming community services

Transforming community services

Transforming community services

Community nurses shall inform policy

The Queen's Nursing Institute plans to road-test the Department of Health's Transformational Guides by involving frontline practitioners to help shape future web-based versions.

Transforming Community Services programme

Transforming Community Services programme